The usefulness of EUS‐FNA with contrast‐enhanced harmonic imaging of solid pancreatic lesions: A prospective study

Abstract

Background and Aim: Few studies have investigated endoscopic ultrasound-guided fineneedle aspiration with contrast-enhanced harmonic imaging (EUS-FNA-CHI) for diagnosing and adequately sampling pancreatic lesions. This study aimed to investigate the efficacy of EUS-FNA-CHI compared with that of endoscopic ultrasound-guided fine-needle aspiration with fundamental B mode imaging (EUS-FNA-FBI) for diagnosing solid pancreatic lesions. Methods: Consecutive patients with solid pancreatic lesions were enrolled prospectively (UMIN 000024467). Only samples obtained during the first needle pass (EUS-FNA-FBI) and second needle pass (EUS-FNA-CHI) were used to compare the accuracy rate for diagnosing pancreatic lesions and rate of adequate sampling for histological evaluation. In patients with hypo-enhancing lesions on contrast-enhanced harmonic EUS (CH-EUS), subgroup analyses were performed. Patients were classified into those with a heterogeneous area in the whole lesion (whole group), those with a heterogeneous area with a non-enhancing area (non-enhancing group), and those with a heterogeneous area with a homogeneous area (homogeneous group). Results: Ninety-three patients were enrolled. Overall, the rates of adequate sampling and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI (84.9% vs 68.8%, P = 0.003 and 76.5% vs 58.8%, P = 0.011, respectively). The adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI when the mass was > 15 mm. In the non-enhancing and homogeneous groups, the adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI. Conclusions: CH-EUS enables improved observation of pancreatic lesions and helps identify the target of EUS-FNA among different pathological areas of the lesions particularly of > 15 mm. The usefulness of EUS-FNA-CHI M Itonaga et al.

Contrast-Enhanced Harmonic Endoscopic Ultrasound-Guided Fine-Needle Aspiration versus Standard Fine-Needle Aspiration in Pancreatic Masses: A Propensity Score Analysis

“…Targeting FNA based on the contrast enhancement pattern could reasonably be considered able to decrease the number of needle passes needed to obtain adequate samples; instead, no difference concerning this parameter was observed in our study (2.4 ± 0.6 and 2.7 ± 0.8, respectively; p = 0.76), again in line with the current literature [ 10 , 17 , 18 ].…”

“…According to the current guidelines, two phases were described: a) the arterial phase, starting from around 10–20 s until around 35–40 s after contrast injection, and b) the venous phase, starting from around 30–45 s after contrast injection [ 25 ]. When a pancreatic lesion was diagnosed as pancreatic adenocarcinoma by CH-EUS, the hypoenhancement area of the lesion was selected as a target area for FNA ( Figure 1 ); on the other hand, when the CH-EUS diagnosis was focal pancreatitis or a neuroendocrine tumor, the iso- or hyperenhancement area of the lesion was selected, according to the current literature [ 10 , 11 , 16 , 17 , 18 ]. The FNA site was monitored simultaneously by endosonography.…”

“…Five series directly compared CH-EUS-FNA to standard EUS-FNA [ 10 , 11 , 16 , 17 , 18 ], of which two randomized-controlled trials (RCTs) [ 10 , 16 ] have been published so far with conflicting results. Therefore, whether CH-EUS-FNA might lead to a significant increase in diagnostic sensitivity and accuracy as compared to EUS-FNA remains an open debate.…”

Tissue is the issue?

“…Similarly, in a prospective study that included 93 patients, the authors concluded that CE-EUS improved FNA outcomes compared with conventional EUS-FNA. However, the reported first pass rates of adequate sampling and sensitivity in the conventional arm was also low (CE-EUS vs. EUS: 84.9 % vs. 68.8 %, P = 0.003 and 76.5 % vs. 58.8 %, P = 0.01, respectively) [3]. Thus, the results of these studies may be misleading in suggesting the superiority of CE-EUS.…”

Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) with Image Enhancement

“…While heterogeneous areas on CH-EUS are indicative of a tumor, homogeneous areas are associated with inflammation of the tissues surrounding the tumor. The rates of adequate sampling and sensitivity were found to be significantly higher with EUS-FNA with CH-EUS than with conventional EUS-FNA, as the former avoids non-enhancing and homogeneous areas in hypo-enhancing lesions [53] ( Table 1). Thus, CH-EUS improves the ability of EUS-FNA to identify pancreatic lesions and targets areas within these lesions for sampling.…”